Two years ago, DN reported on widespread “racism” in healthcare, where patients requested ethnically Swedish doctors. The report highlighted that it was not about language skills, but the doctor’s origin. Sharp reactions followed from both politics and healthcare, with the unanimous response being that it should not be possible to choose doctors based on origin. However, there may be cases where a doctor’s cultural knowledge, including their origin, can be valuable in treating a patient. For example, an association in the Gothenburg district of Hammarkullen invited a Swedish-Somali psychologist to talk about mental illness and what psychology can do to help people, which can encourage minorities to seek care. Cultural knowledge of minorities is often incomplete in Swedish healthcare, and understanding people’s environments and experiences is not easy during short hospital visits. Conversely, Sweden’s majority population can also experience cultural clashes when encountering healthcare staff with origins outside of Sweden. However, some patients may feel more comfortable with care providers with whom they feel an implicit connection. To deny patients the choice of a competent care provider based on cultural knowledge may worsen their health and life chances in the long run. The multicultural society raises complex questions that require more sophisticated answers than simply stating that racism is unacceptable.
For two years then DN revealed that there is widespread “racism” in healthcare. It was about patients who had requested ethnically Swedish doctors. It was underlined in the report that it was not about language skills when choosing a doctor, but the origin itself. Many caregivers met the fictitious patient.
Sharp reactions came directly from both politics and healthcare: It should not be possible to choose doctors based on origin was the unanimous response. A discussion about racism in healthcare followed.
But can there be cases when the doctor’s cultural knowledge – of which origin can be a clue – can be valuable in the encounter with a patient?
In a feature that SVT did recently, we meet Roda Hassan who, together with her mother, started an association in the Gothenburg district of Hammarkullen to spread knowledge and get minorities to speak openly about sensitive issues. Recently, the association had invited the Swedish-Somali psychologist Yassin Ekdahl to talk about mental illness and what psychology can do to help people.
It is an exemplary initiative that has the potential to get people from minorities to seek care. Swedish health care’s knowledge of minorities, which includes their cultural characteristics and experiences, is often incomplete. It’s not that weird. Understanding which environments shape people – and thereby their perception of illness, both somatic and psychiatric – is not easy to find out only during a short visit to the hospital.
But it applies also in the other direction. Swedish care, especially psychiatry, is not entirely easy to understand for those who have not grown up in a Swedish environment. This can apply even if you have lived most of your life in Sweden. Culture is not a thin veneer in our lives that only concerns food, clothing and customs, it can also touch on purely existential issues.
An example of this is given by the psychologist Yassin Ekdahl, who in the feature addresses three common myths about mental illness among some of those who have come to Sweden from countries in the Middle East and Africa: According to these beliefs, mental problems are considered to be caused by evil spirits, insufficient faith in God or other supernatural explanations. Those suffering from mental illness are also sometimes kept locked up and hidden away.
Because of these superstitious beliefs, seeing a psychologist can therefore be associated with a serious stigma. Taking a child to a psychologist, for example for learning problems, can give the child a bad reputation, which can also affect the family as a whole. It is not difficult to figure out that this means that many do not receive the care they would need, which worsens health and life chances in the long run.
But what happens if you actually seek care? It is not certain that an ethnically Swedish doctor possesses the knowledge, or the experiences, required to fully understand a patient who has not grown up in a Swedish cultural environment. In such cases, is it unreasonable that such a patient, to the extent possible, can choose a care provider who possesses that competence?
In many situations is probably impossible. And in some situations it is actually possible to learn about the specific cultural context that can provide answers to certain questions about the patient’s conditions and needs. But there is a lack of such cultural knowledge in Sweden. Then it is clearly easier to arrive at such an answer for a doctor who actually has an “inside” understanding of the patient’s background and home environment.
Sweden is a very heterogeneous country. Many of the problems that arise in the encounter between the majority population and minorities are based on a most understandable ignorance. It goes both ways. It is not only minorities who can experience cultural clashes in the encounter with care. Even people from the majority population, when they meet healthcare staff with origins outside of Sweden, may encounter language confusion, of both a cultural and linguistic nature.
It does not rule out that some patients are really driven by racist beliefs when they encounter healthcare. But there are probably far more cases when patients in a situation where they have to bare their innermost being, be it physiological or psychological, can be more comfortable with a care provider with whom they feel an implicit connection.
Two years ago, this discussion ended with statements that racism is unacceptable and that no patient should be allowed to choose their doctor based on their ancestry. But it is a completely inadequate answer to some of the questions that the multicultural society raises. It is fortunate that some, like Roda Hassan and Yasin Ekdahl, try to answer them more sophisticatedly.
READ MORE: Am I one of those racist patients?